Program Specialist II

Program Specialist II

The Program Specialist II will provide dedicated support to patients and doctors for activities related to benefit coverage, payments, reimbursements, denials and general inquiry phone calls through our patient services support center.

Work Schedule / Availability Requirements

• Must have open availability between 8:00 AM and 8:00 PM EST, based on program and business needs.
• Schedule may vary and will be assigned within the program operating hours.
• Weekend availability is required. Candidates must be flexible and available to work shifts on both Saturdays and Sundays.
• Program Hours:
• Monday through Friday: 8:00 AM to 8:00 PM EST
• Saturday and Sunday: 9:00 AM to 5:00 PM EST

Essential Duties and Responsibilities: Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by:

• Provide dedicated, personalized support delivered over the phone and via online portal.
• Complete investigations and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs. Collaborate with patients and doctors to assist with issues related to payments, reimbursements, payment denials, and appeals. Make outbound calls to customers for additional information.
• Assist with prior authorization and medical necessity processes, benefit verification and prior authorization assistance.
• Administer comprehensive searches for alternate reimbursement resources, such as state and federal assistance programs, and enrollment assistance for qualified patients.
• Respond to inquiries from customers, sales representatives and business partners, and follow up on requests in a timely, courteous and professional manner. Maintain positive attitude and a helpful approach to customers and clients.
• Enter orders, change orders, track shipments, and enter customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.
• Process patient assistance applications according to business rules of program.
• Other tasks and projects as assigned

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Expectations of the Job:

• Assist with benefit verifications and prior authorizations
• Enter orders, change orders, and enter customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.
• Act as the primary point of contact for healthcare providers to obtain complete patient enrollment and insurance information
• Learn, understand and follow all company and client policies and procedures.
• Focus on results in a professional, ethical, and responsible manner when dealing with customers, vendors, team members, and others.
• Accept being accountable and responsible in work practices and expectations. Delivers what is promised.
• Foster a collaborative, team-oriented attitude. Communicates effectively with others with clarity and transparency.
• Use innovative critical and creative thinking to evaluate and solve work and customer issues.
• Seek assistance in solving work problems through collaboration and information seeking.
• Excellent attendance

The above list reflects the general details necessary to describe the expectations of the position and shall not be construed as the only expectations that may be assigned for the position.

An individual in this position must be able to successfully perform the expectations listed above.

Qualifications

Minimum Knowledge, Skills and Abilities:

• High School Diploma and 4 years' experience or Associate's Degree and 2 years' experience in healthcare setting
• Excellent oral, written, and interpersonal communication skills.
• Ability to multi task.
• Positive attitude.
• Accurate and detail-orientated.
• Ability to work independently and function as a team player.
• Ability to work in a fast paced, metric driven environment, while remaining patient minded.
• Strong computer skills with a working knowledge of Microsoft Word, Excel, and PowerPoint.

Preferred Qualifications:

• Customer service and/or call center experience
• Patient assistance, reimbursement and/or pharmacy benefit management experience
• Medical billing and coding experience

Additional Information

Our Cultural Beliefs:

• Patient Minded I act with the patient's best interest in mind.
• Client Delight I own every client experience and its impact on results.
• Take Action I am empowered and empower others to act now.
• Grow Talent I own my development and invest in the development of others.
• Win Together I passionately connect with anyone, anywhere, anytime to achieve results.
• Communication Matters I speak up to create transparent, thoughtful and timely dialogue.
• Embrace Diversity I create an environment of awareness and respect.
• Always Innovate I am bold and creative in everything I do.